"Blood glucose at all levels, even those below the threshold we call diabetes, is responsible for a very large number of cardiovascular deaths in the world, in fact, substantially larger than the number that directly die of diabetes," said lead researcher Majid Ezzati, an associate professor of international health at the Harvard School of Public Health.

His team published its report in the Nov. 11 issue of The Lancet.

In the study, Ezzati's group looked at the effects of higher-than-optimum concentrations of blood sugar on death from heart disease and stroke worldwide. They gathered data on blood sugar from 52 countries in different parts of the world.

The researchers found that 959,000 deaths in 2001 were directly attributed to diabetes, 1,490,000 to heart disease and 709,000 to stroke, and all were linked to high blood sugar. This means that 21 percent of all deaths from heart disease and 13 percent of all deaths from stroke are associated with high blood sugar.

Higher-than-optimum blood sugar accounts for 3.16 million deaths a year. This is substantially higher than the deaths attributed to diabetes alone. Deaths from high blood sugar are comparable to the 4.8 million deaths from smoking, the 3.9 million deaths from high cholesterol and the 2.4 millions deaths from overweight and obesity each year, the researchers note.Ezzati thinks that these findings indicate that blood sugar should be considered a risk factor beyond the risk for diabetes. Like blood pressure control, lowering blood sugar reduces the risk for heart disease.

"At all levels of blood glucose, it seems that higher is worse," Ezzati said. "Most people can benefit from having lower blood glucose, in the same way we think about blood pressure," he said.

Ezzati believes that people need to know about the risks of high blood sugar. Public health programs that highlight the risks of high blood sugar are needed, in the same way that there are programs about the risks of high blood pressure and high cholesterol, he said.

One expert agrees that lowered blood sugar reduces the risk for heart disease and stroke as well as diabetes.

"This is not news to me," said Dr. Larry Deeb, the president for Medicine and Science at the American Diabetes Association. "We have been dealing with this in the diabetes community for a while."

Blood sugar is a variable, like blood pressure and cholesterol, that is associated with deaths from heart disease and stroke, Deeb said. "All of those variables -- the lower the better," he said.The key to keeping blood sugar low is lifestyle, especially diet and exercise, Deed said.In a related study in the same journal issue, Finnish researchers found that diet and exercise counseling can change lifestyle and reduce the incidence of diabetes among people at high risk for type 2 diabetes.

"From a public health point of view, there is an important message: An intensive lifestyle intervention lasting for a limited time can yield long-term benefits in reducing the risk of type 2 diabetes in high-risk individuals," researcher Jaakko Tuomilehto, from the Diabetes Unit in the Department of Health Promotion and Chronic Disease Prevention at the National Public Health Institute, Mannerheimintie, said in a prepared statement.

"Although a lifestyle intervention alone, even if successful, does not necessarily prevent type 2 diabetes in all individuals, it will still postpone the onset of the disease," Tuomilehto said. "Even delaying the onset of diabetes can have a substantial effect on subsequent morbidity, and therefore on the cost-effectiveness of diabetes prevention."

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